Extra-capsular floating fat at the extremity: a review.

Extra-capsular floating fat may present in a variety of non-articular locations at the extremity. Manifestation of floating fat or fat-fluid level(s) outside of a joint is a marker of trauma or infection. Recognizing radiologic sign(s) of extra-capsular floating fat can aid radiologists to provide an informed differential diagnosis and facilitate clinical care. This review discusses the etiology, mechanisms, and imaging appearance of extracapsular floating fat in specific anatomic and non-anatomic locations at the extremity.

Multistep Crystallization of Dynamic Nanoparticle Superlattices in Nonaqueous Solutions.

Crystallization is a universal phenomenon underpinning many industrial and natural processes and is fundamental to chemistry and materials science. However, microscopic crystallization pathways of nanoparticle superlattices have been seldom studied mainly owing to the difficulty of real-time observation of individual self-assembling nanoparticles in solution. Here, using in situ electron microscopy, we directly image the full self-assembly pathway from dispersed nanoparticles into ordered superlattices in nonaqueous solution. We show that electron-beam irradiation controls nanoparticle mobility, and the solvent composition largely dictates interparticle interactions and assembly behaviors. We uncover a multistep crystallization pathway consisting of four distinct stages through multi-order-parameter analysis and visualize the formation, migration, and annihilation of multiple types of defects in nanoparticle superlattices. These findings open the door for achieving independent control over imaging conditions and nanoparticle assembly conditions and will enable further study of the microscopic kinetics of assembly and phase transition in nanocolloidal systems.

Prospective Characterization of Pain and Function in Patients With Unstable Pelvic Fractures Treated With Posterior Screw Fixation.

OBJECTIVES: Describe patient-reported pain and function within 24 months of a pelvic fracture treated with posterior screw fixation and identify factors associated with increased pain. DESIGN: Prospective case series. SETTING: Academic trauma center. PATIENTS/INTERVENTION: Eighty-eight patients with adult pelvic fracture treated with sacroiliac or transiliac screws. MAIN OUTCOME MEASURES: Average pain measured with the Brief Pain Inventory (BPI); function measured with the Majeed Pelvic Outcome Score from 6 to 24 months postinjury. RESULTS: The mean pain from 6 to 24 months postinjury was 2.22 on the 10-point BPI scale (95% CI, 0.64-3.81). Sixty-nine patients (78.4%) reported mild to no pain at 6 months; 12 (13.6%) patients had severe pain. Two years after injury, 71 patients (80.6%) exhibited mild to no pain. Within 24 months of injury, the mean pelvic function was 71 on the 100-point Majeed scale (95% CI, 60-82). Half of the sample (n = 44) had good to excellent pelvis function by 6 months postinjury; 55 patients (62.5%) attained this level of function by 24 months. A history of chronic pain (1.31; 95% CI, 0.26-2.37; P = 0.02), initial fracture displacement (≥5 mm) (0.99; 95% CI, 0.23-1.69; P = 0.01), and socioeconomic deprivation (0.28; 95% CI, 0.11-0.44; P < 0.01) were significantly associated with increased pain. CONCLUSION: Our findings suggest that most patients with unstable pelvic ring fractures treated with posterior screw fixation achieve minimal to no pelvis pain and good to excellent pelvic function 6-24 months after injury. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison of the RayStation photon Monte Carlo dose calculation algorithm against measured data under homogeneous and heterogeneous irradiation geometries.

PURPOSE: This work compares Monte Carlo dose calculations performed using the RayStation treatment planning system against data measured on a Varian Truebeam linear accelerator with 6 MV and 10 MV FFF photon beams. METHODS: The dosimetric performance of the RayStation Monte Carlo calculations was evaluated in a variety of irradiation geometries employing homogeneous and heterogeneous phantoms. Profile and depth dose comparisons against measurement were carried out in relative mode using the gamma index as a quantitative measure of similarity within the central high dose regions. RESULTS: The results demonstrate that the treatment planning system dose calculation engine agrees with measurement to within 2%/1 mm for more than 95% of the data points in the high dose regions for all test cases. A systematic underestimation was observed at the tail of the profile penumbra and out of field, with mean differences generally <0.5 mm or 1% of curve dose maximum respectively. Out of field agreement varied between evaluated beam models. CONCLUSIONS: The RayStation implementation of photon Monte Carlo dose calculations show good agreement with measured data for the range of scenarios considered in this work and is deemed sufficiently accurate for introduction into clinical use.

Recycling and Reprocessing of Thermoplastic Polyurethane Materials towards Nonwoven Processing.

Thermoplastic Polyurethane (TPU) is a unique tailorable material due to the interactions of hard and soft segments within the block-copolymer chain. Therefore, various products can be created out of this material. A general trend towards a circular economy with regards to sustainability in combination with TPU being comparably expensive is of high interest to recycle production as well as post-consumer wastes. A systematic study investigating the property changes of TPU is provided, focusing on two major aspects. The first aspect focuses on characterizing the change of basic raw material properties through recycling. Gel permeation chromatography (GPC) and processing load during extrusion indicate a decrease in molar mass and consequently viscosity with an increasing number of recycling cycles. This leads to a change in morphology at lower molar mass, characterized by differential scanning calorimetry (DSC) and visualized by atomic force microscope (AFM). The change in molar mass and morphology with increasing number of recycling cycles has an impact on the material performance under tensile stress. The second aspect describes processing of the recycled TPU to nonwoven fabrics utilizing melt blowing, which are evaluated with respect to relevant mechanical properties and related to molecular characteristics. The molar mass turns out to be the governing factor regarding mechanical performance and processing conditions for melt blown products.

Evaluation of the RayStation electron Monte Carlo dose calculation algorithm.

The aim of this work was to evaluate the accuracy of the RayStation treatment planning system electron Monte Carlo algorithm against measured data for a range of clinically relevant scenarios. This was done by comparing measured percentage depth dose data (PDD) in water, profiles at oblique incidence and with heterogeneities in the beam path, and output factor data and that generated using the RayStation treatment planning system Monte Carlo VMC++ based calculation algorithm. While electron treatments are widely employed in the radiotherapy setting accurate modelling is challenging (TPS) in the presence of patient being both heterogeneous and nonrectangular. Watertank-based measurements were made on a Varian TrueBeam linear accelerator covering electron beam energies 6 to 18 MeV. These included both normal and oblique incidence, heterogeneous geometries, and irregular shaped cut-outs. The measured geometries were replicated in RayStation and the Monte Carlo dose calculation engine used to generate dosimetric data for comparison against measurement in what were considered clinically relevant settings. Water-based PDDs and profile comparisons showed excellent agreement for all electron beam energies. Profiles measured with oblique beam incidence demonstrated acceptable agreement to the treatment planning system calculations although the correspondence worsened as the angle increased with the planning system overestimating the dose in the shoulder region. Profile measurements under inhomogeneities were generally good. The planning system had a tendency to overestimate dose under the heterogeneity and also demonstrated a broader penumbra than measurement. Of the 170 different output factors calculated in RayStation over the range of electron energies commissioned, 141 were within ± 3% of measured values and 164 within ± 5%. Four of the 6 comparisons beyond 5% were at 18 MeV and all had a cut-out edge within 3 cm of the beam central axis/measurement point. The RayStation implementation of a VMC++ electron Monte Carlo dose calculation algorithm shows good agreement with measured data for a range of scenarios studied and represented sufficient accuracy for clinical use.

A Brief Smoking Cessation Intervention for Heavy Drinking Smokers: Treatment Feasibility and Acceptability.

Approximately 20-25% of regular smokers report heavy drinking. Abstinent smokers are five times as likely to experience a smoking lapse during drinking episodes. Current efforts seek to improve treatments for this subgroup of heavy-drinking smokers. This study tested the feasibility and acceptability of addressing alcohol use in a brief, single session smoking cessation intervention (SMK+A) compared to smoking cessation counseling only (SMK); these interventions were grounded in a motivational interview framework and included personalized feedback, decisional balance, quit day setting, and tailored skills building (e.g., breathing techniques, coping with urges, dealing with social pressures) to maintain abstinence. Descriptive outcomes included reported helpfulness of intervention skills, readiness to change scores, and feasibility of participant recruitment and retention. We also assessed 7-day point prevalence of smoking cessation, and smoking and drinking reduction at 1-month follow-up. Participants (N = 22) were community-based treatment-seeking daily smokers (≥5 cigarettes/day) who were also heavy drinkers (≥14 drinks/week for men, ≥ 7 drinks/week for women; or ≥5 drinks on one episode in past week for men, ≥4 for women). Twenty five percent of interested individuals were eligible after initial phone screen, and all randomized participants were retained through follow up. All skills demonstrated high acceptability (i.e., rated between moderately and very helpful), and a significant proportion of participants in each condition reported taking action to reduce cigarette smoking and/or alcohol use at 1-month post-quit. Three participants in each condition (27.3%) attained bioverified (CO ≤ 4 parts per million and cotinine ≤ 3 ng/mL) smoking quit at follow-up. Given the modified intervention's acceptability and flexibility, larger studies may help to elucidate this intervention's effects on readiness to change, smoking cessation, and alcohol reduction.

Examining the Sexual Health Consequences of Alcohol Consumption Among Black Gay and Bisexual Men.

BACKGROUND: Black men who have sex with men (MSM) are disproportionately affected by HIV infection. Efforts are needed to understand correlates of HIV risk among this group. Alcohol consumption may have a role in HIV transmission given its association with condomless sex. This study aimed to examine the association between alcohol consumption (i.e., drinking before/during sex and levels of alcohol use problems) and condom use during lifetime, past 6 months, and the event (i.e., a specific sexual episode) level. METHODS: Black MSM (N = 102) reported sexual behavior and condom use for lifetime, past 6 months, and the most recent condom and condomless sex events. The Alcohol Use Disorders Identification Test (AUDIT) determined alcohol use problems. RESULTS: Ordinal and binary regression analyses analyzed associations between AUDIT scores and condomless sex (receptive and insertive). AUDIT scores were associated with a greater likelihood of condomless sex (lifetime receptive sex: OR = 1.06, p < 0.05; past 6 months insertive sex: odds ratio [OR] = 1.09, p < 0.01). At the event level, there was no greater likelihood of drinking during last condomless sex as compared to last condom sex, χ2 (1) = 0.18, p = 0.39. CONCLUSIONS: There was evidence that an increase in alcohol use problems was associated with a greater likelihood of risky sexual behavior. Drinking before/during sex was not related to condom use. These findings contribute to understanding the nuanced relationship between alcohol use and sexual risk.

HIV/AIDS conspiracy beliefs and intention to adopt preexposure prophylaxis among black men who have sex with men in Los Angeles.

In the United States, black men who have sex with men (MSM) are the group most affected by the HIV/AIDS epidemic. Pre-exposure prophylaxis (PrEP) is an important new HIV prevention strategy that may help reduce new HIV infections among black MSM. This analysis examined the association between HIV/AIDS conspiracy beliefs and intentions to adopt PrEP among 224 black MSM. The likelihood of adopting PrEP was assessed and more than half (60%) of the study population indicated a high intention to adopt PrEP. HIV/AIDS genocidal and treatment-related conspiracies were assessed using scales previously validated with black MSM. Almost two-thirds (63%) endorsed at least one of eight HIV/AIDS conspiracy beliefs presented. In multivariable analyses, black MSM who agreed with the genocidal or treatment-related conspiracy beliefs scales had a lower intention to adopt PrEP (Adjusted Odds Ratio [AOR] = 0.73, 95% CI = 0.54, 0.99 and AOR = 0.36, 95% CI = 0.23, 0.55, respectively). Our findings indicate that preexisting HIV/AIDS conspiracy beliefs may deter some black MSM from adopting PrEP. We suggest strategies PrEP implementers may want to employ to address the influence that HIV/AIDS conspiracy beliefs may have on the adoption of PrEP among black MSM, a population disproportionately affected by HIV/AIDS.

The Association Between Alcohol Consumption and Condom Use: Considering Correlates of HIV Risk Among Black Men Who Have Sex with Men.

Epidemiological data indicate Black men who have sex with men (MSM) are the most at-risk group for HIV infection. However, the factors driving this disparity are not fully understood. Condom use remains a significant point of intervention in mitigating sexually transmitted infections. Alcohol consumption is highly prevalent among Black MSM, has a significant role in the culture of sex, and may significantly interfere with condom use. This review will examine the relationship between alcohol consumption and condom use among Black MSM. In this review we, (a) discuss the prevalence of alcohol use among MSM and its association with condom use; (b) consider the role of alcohol in the culture of MSM; (c) review the literature on the relationship between alcohol and condom use; and (d) discuss the role of several empirically-supported moderating variables in strengthening the relationship between alcohol use and noncondom use. This review places the finding and implications for HIV risk among Black MSM in the context of the broader literature on MSM.

Perceptions of and intentions to adopt HIV pre-exposure prophylaxis among black men who have sex with men in Los Angeles.

This study assessed perceptions of pre-exposure prophylaxis (PrEP) and their association with PrEP adoption intention among a convenience sample of 224 low socioeconomic status black men who have sex with men (BMSM) residing in Los Angeles. Participants received educational information about PrEP and completed an in-person interview. More than half (60%) of the participants indicated a high intention to adopt PrEP. Younger BMSM (18-29 years) were twice as likely to report a high intention to adopt PrEP compared to older BMSM (30+ years). Only 33% of participants were aware of PrEP and no participant had ever used PrEP. Negative perceptions were associated with a lower PrEP adoption intention and included being uncomfortable taking an HIV medicine when HIV-negative and not knowing if there are long-term side effects of taking an HIV medication. These findings suggest that BMSM may adopt PrEP but that negative perceptions may limit its uptake among this population. In order to facilitate PrEP adoption among BMSM targeted educational and community awareness programmes are needed to provide accurate information on the benefits of PrEP and to address the negative perceptions of PrEP held by local BMSM populations.

The relationship between methamphetamine and alcohol use in a community sample of methamphetamine users.

BACKGROUND: While methamphetamine (MA) and alcohol are often used in combination, little is known about the pattern of co-use between these substances. The goal of the present study is to examine the relationship between MA use and alcohol use in a community sample of non-treatment seeking regular MA users. METHODS: Participants completed a face-to-face assessment battery, which included a diagnostic interview for MA dependence and the timeline follow-back interview for both alcohol and MA use over the past 30 days. Sixty regular MA and alcohol users supplied data for 1800 person-days. RESULTS: Compared with non-drinking days, drinking days and binge drinking days increased the odds of same day MA use by 4.22 and 4.50 times, respectively (p's<0.0001). Further, binge drinking incrementally increased risk for MA use above and beyond the effects of drinking itself (p<0.0001). Lagged models revealed previous day MA use to predict following day MA use (p<0.0001), yet, after controlling for this relationship, neither previous day alcohol use nor previous day binge drinking predicted following-day MA use. Finally, the effect of binge drinking on MA use was stronger among individuals with lower MA dependence severity or higher alcohol problem severity (p's<0.05). CONCLUSIONS: These results suggest that alcohol and MA are co-used in predictable patterns, and in particular, that binge drinking may be incrementally associated with the likelihood of MA use. Future studies are needed to explore the temporal relationship between alcohol and MA use within a given episode.

Depression among Black bisexual men with early and later life adversities.

This study examined the role of adulthood adversities in the relationship between childhood adversities and depression in 117 HIV-positive Black men who have sex with men and women (MSMW) and who have histories of childhood sexual abuse (CSA). Men were participants in the Enhanced Sexual Health Intervention for Men, a 6-session health intervention, and, at baseline, reported their experiences of CSA, childhood adversities, perceived discrimination, chronic stress, social support, and depressive symptoms. The relationship between childhood adversities, including CSA, and depression was mediated by experiences with racial and HIV discrimination, R² = .25, F(3, 112) = 12.67, p < .001, and chronic stress, R² = .17, F(3, 112) = 7.41, p < .001. Social support moderated the mediated effects of both racial and HIV discrimination, b = -.154, t(111) = -2.82, p < .01, and chronic stress, b = -.019, t(111) = -3.759, p < .01. Men's early adverse experiences were predictive of depression in adulthood; however, this relationship was largely affected by adulthood experiences, specifically discrimination, high chronic stress, and low social support. These findings illustrate pathways by which Black MSMW's early vulnerability for depression is either exacerbated or attenuated by their experiences as adults.

Effects of patient-provider race concordance and smoking status on lung cancer risk perception accuracy among African-Americans.

BACKGROUND: Communication of lung cancer risk information between providers and African-American patients occurs in a context marked by race-based health disparities. PURPOSE: A controlled experiment assessed whether perceived physician race influenced African-American patients' (n = 127) risk perception accuracy following the provision of objective lung cancer risk information. METHODS: Participants interacted with a virtual reality-based, simulated physician who provided personalized cancer risk information. RESULTS: Participants who interacted with a racially discordant virtual doctor were less accurate in their risk perceptions at post-test than those who interacted with a concordant virtual doctor, F(1,94) = 4.02, p = .048. This effect was amplified among current smokers. Effects were not mediated by trust in the provider, engagement with the health care system, or attention during the encounter. CONCLUSIONS: The current study demonstrates that African-American patients' perceptions of a doctor's race are sufficient to independently impact their processing of lung cancer risk information.

Issues in the Assessment of "Race" among Latinos: Implications for Research and Policy.

Measurement of race and ethnicity is integral to assessing and addressing health disparities experienced by minorities. However, the unique experiences of Latinos related to race and the discordance between understandings of race among Latinos and the predominant U.S. conceptualizations of this construct impact how Latinos respond to measurement approaches. As a result, data collection methodologies often yield ambiguous responses that reveal little about this population. This paper examines Latinos' racial responding, and how this relates to their experiences and understanding of their racial identity. We recommend the use of a combined race and ethnicity question and open-ended race and ethnicity questions, when feasible, which will likely yield more meaningful data that can be used to address this populations' health needs.

Informational content, literacy demands, and usability of websites offering health-related genetic tests directly to consumers.

PURPOSE: As direct-to-consumer genetic testing becomes more available, a diverse group of consumers, including those with limited health literacy, may consider testing. In light of concerns raised about direct-to-consumer genetic testing, this study sought to critically examine whether the informational content, literacy demands, and usability of health-related direct-to-consumer websites met existing recommendations. METHODS: A content analysis was performed on 29 health-related direct-to-consumer websites. Two coders independently evaluated each website for informational content (e.g., benefits, limitations), literacy demands (e.g., reading level), and usability (e.g., ease of navigation). RESULTS: Most sites presented health conditions and some markers for which they tested, benefits of testing, a description of the testing process, and their privacy policy. Fewer cited scientific literature, explained test limitations, or provided an opportunity to consult a health professional. Key informational content was difficult to locate on most sites. Few sites gave sample disease risk estimates or used common language and explained technical terms consistently. Average reading level was grade 15. CONCLUSION: The quality of informational content, literacy demands, and usability across health-related direct-to-consumer websites varied widely. Many users would struggle to find and understand the important information. For consumers to better understand the content on these sites and evaluate the meaning of the tests for their health, sites should lower the demands placed on users by distilling and prioritizing the key informational content while simultaneously attending to the reading level and usability elements. In the absence of regulation compelling such changes, government agencies or professional organizations may need to increase consumer and provider awareness of these issues.